Abstract WMP64: Association between ipsilateral stroke and non-stenotic (<50%) carotid disease – Analysis from the Alteplase compared to Tenecteplase Trial
Bibliographic record
Abstract
Background and Objectives: Emerging literature suggests that non-stenotic carotid disease (<50% stenosis), especially in the presence of high-risk plaque features, can be a possible etiology for ischemic stroke. We aimed to evaluate the odds of concordant stroke among individuals with non-stenotic carotid arteries with various plaque features. Methods: This is a secondary analysis from the Alteplase compared to Tenecteplase (AcT) trial. We evaluated carotid arteries on baseline CT Angiogram (CTA) to assess the degree of stenosis, plaque features such as ulceration, thickness, irregularity, hypodensity and presence of intraluminal thrombi, carotid web and dissection. 24hour follow-up imaging was used to evaluate stroke location. At a carotid level, we performed mixed effects logistic regression analysis adjusted for age and sex, with patient ID as a random effects variable, to determine the association between each high-risk plaque feature and the presence of concordant stroke (ipsilateral acute stroke in the territory of the carotid artery). Results: Of 1577 patients in the trial, 1407 (89.2%) had interpretable baseline imaging. Of these, 329 (23.4%) had no carotid disease, 869 (61.8%) had non-stenotic (<50%) carotid disease and 209 (14.9%) had stenotic (>50%) carotid disease. At a carotid level, 2519 (89.5%) had non-stenotic carotid disease. Of these, 689 (27.4%) had concordant stroke. Intraluminal thrombi and carotid webs were significantly associated with concordant stroke (aOR 8.11, 95% CI 1.6 – 41.08 and aOR 3.58, 95% CI 1.53 – 8.35, respectively). None of the other plaque features were significantly associated with concordant stroke. Conclusions: Among patients with non-stenotic carotid disease, only the presence of intraluminal thrombi and carotid webs were found to be associated with increased odds of concordant stroke. Further CTA-based studies on larger populations are required to identify plaque features associated with concordant ischemic stroke.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".